The impact of acute care clinical practice guidelines on length of stay: A closer look at some conflicting findings

Moriah Ellen, G. Ross Baker, Adalsteinn Brown

Abstract

Systematic reviews have found that clinical practice guidelines (CPGs) are associated with lower lengths of stay (LOS), but a secondary analysis of Ontario acute care hospitals found few significant relationships between CPGs and LOS. This research explored possible reasons for these findings and what other factors may impact the CPG-LOS relationship. Semi-structured interviews were conducted with staff from nine hospitals whose jobs dealt with developing, implementing, monitoring, updating, or evaluating CPGs. Interviews were analyzed utilizing methods outlined by Aurebach. A variety of leaders and hospital types were represented. Five main factors influencing relationships between CPGs and LOS were identified: 1) the purpose of implementation, 2) evidence base for CPG content and selection, 3) health care professionals’ response to change and compliance, 4) dissemination strategies, and 5) organizational support and resources. The interviews suggested possible reasons why CPGs are not realizing their full potential impact on LOS in Ontario hospitals, ranging from poor compliance to resistance from health care providers. CPGs themselves are not perceived to be the reason for ineffectiveness; rather, organizational- and individual-level barriers seem to be the causes.